Letter from the Chief Inspector of General Practice

Groby Surgery (the provider) had been inspected previously on the following dates:

• 9 May 2017 under the comprehensive inspection programme. The practice was rated Inadequate overall and placed in special measures for a period of six months. Breaches of legal requirements were found in relation to safe care and treatment, safeguarding service users from abuse and improper treatment and governance arrangements within the practice. Warning notices were issued which required them to achieve compliance with the regulations set out in the warning notices by 15 September 2017.

• 14 November 2017- A focused inspection was undertaken to check they met the legal requirements. As the practice had not made all the improvements to achieve compliance with the regulations requirement notices were issued for safe care and treatment and governance arrangements and an action plan was sent in which the practice identified what required improvements would be put in place to ensure compliance of the regulations.

Reports from our previous inspections can be found by selecting the ‘all reports’ link for Groby Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following a six month period of special measures and was an announced comprehensive inspection on 11January 2018.

This practice is rated as Good overall. (Previous inspection May 2017 was Inadequate).

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

At this inspection we found:

• Significant improvements had been made since the inspection in May 2017.

• A leadership structure was in place but we were still not assured that the GP partners had the necessary experience to lead effectively. They were unable to fully demonstrate overall clinical oversight and capability to deliver high quality care.

• We found an improved system in place for reporting and recording significant events, lessons were shared to make sure action was taken to improve safety in the practice. Further work was required to evidence patient impact and outcomes.

• Staff understood their responsibilities to raise concerns and report incidents. These were discussed with relevant staff on a regular basis.

• An effective system was in place to safeguard patients from abuse and improper treatment.

• Patients’ health were monitored in a timely manner to ensure medicines were being used safely and followed up on appropriately.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Feedback we received from patients reflected positively about the staff and said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• We saw that the practice were aware of the reduced performance in the recent GP survey results published in July 2017. The practice had gone on to undertake their own survey in November 2017 and action plans were in plan to drive improvements to patient satisfaction.

• The practice had made improvements to their governance arrangements and had taken a lot of the appropriate steps required to ensure patients remained safe. Further work was still required in regard to significant events and quality improvement to improve patient outcomes.

• There was limited innovation, service development and improvement.

The areas where the provider should make improvements are:

• Ensure GP partners have the necessary experience to lead effectively. They must be able to demonstrate overall clinical oversight and capability to lead effectively to deliver high quality care.

• Continue to embed the improved system in place for reporting and recording significant events to ensure there is evidence of patient impact and outcomes where appropriate.

• Review the system in place for the monitoring of emergency equipment and medicines and ensure it is carried out as per practice policies.

• Provide guidance and training for staff in the recognition of Sepsis
• Improve the monitoring of prescribing to ensure it is in line with national clinical guidance and current best practice. For example, antimicrobials.
• Continue the plan to drive improvement through clinical audit to ensure it is embedded and changes monitored to sustain improvement.
• Implement the NHS England Accessible Information Standard.
• Continue to monitor the National Patient Survey data and continue to make changes to improve the experience of patients.
• Consider an audit of the process for consent to ensure it is accurately recorded on the patient record.
• Put a plan in place to ensure the practice nurse has regular clinical supervision which is documented.
• Ensure discussions on poor performance are documented.
• Continue to review meeting minutes to ensure they contain details of the discussions that have taken place and actions identified are completed.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Groby Surgery on 9 May 2017.

Breaches of legal requirements were found in relation to safe care and treatment, safeguarding service users from abuse and improper treatment and governance arrangements within the practice.

We issued the practice with three warning notices requiring them to achieve compliance with the regulations set out in those warning notices by 15 September 2017.

We undertook this focused inspection on 14 November 2017 to check that they now met the legal requirements. This report only covers our findings in relation to those requirements.

At the inspection on 14 November 2017 we found that not all the requirements of the warning notices had been met.

Our key findings across the areas we inspected for this focussed inspection were as follows:

• The practice had made improvements to their governance arrangements and had taken some of the appropriate steps required to ensure patients remained safe. Further work was required in regard to significant events, management of legionella, quality improvement to improve patient outcomes and complaints.

• Safe systems were now in place for fire safety, high risk medicines, monitoring of the cold chain, staff recruitment and training, appraisals, use of locums, disability access and polices to provide guidance to staff.
• Effective systems were now in place to safeguard service users from abuse and improper treatment.
• At this inspection we still had concerns in regard to the leadership capacity and clinical oversight of the practice.

As the legal requirements of the warning notices for Regulations 12 and 17 were not met in full the Care Quality Commission has issued requirement notices in which we require them to send us action plans on how they will meet these requirements.

The areas where the provider must make improvements are:

• Continue to review the system in place for significant events to ensure all events are captured, investigations are detailed, actions are identified and implemented. Ensure trends are analysed and action is taken to improve the quality of care as a result

• Further review the system in place for legionella management.

• Further review the arrangements in place for quality improvement to monitor and improve patient outcomes.

• Further consolidate the complaints process and ensure all complaints are captured and learning from complaints is documented, discussed and shared with staff. Ensure trends are analysed and action is taken to improve the quality of care as a result.
• Ensure there is leadership capacity and clinical oversight in the practice.
• Ensure Care Quality Commission inspection report ratings are displayed in the practice.

The areas where the provider should make improvements are:-

• Have a system in place to review and monitor information in regard to management of the cold chain. For example, from the data loggers.

• Ensure there is monitoring for external training required by staff members.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Groby Surgery on 9 May 2017. Overall the practice is rated as inadequate.

Our key findings across all the areas we inspected were as follows:

• Patients were at risk of harm because some systems and processes in place were not effective to keep them safe. For example, significant events, safeguarding, monitoring of patients on high risk medicines, monitoring of the cold chain, recruitment and retention of staff.

• There was a system in place for reporting and recording significant events but it was not consistent or clear. Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• The practice did not have effective systems in place to safeguard service users from abuse and improper treatment.
• Risks to patients were assessed and managed, with the exception of those relating to fire and legionella.
• We saw limited evidence of quality improvement to improve patient outcomes.
• The practice did not have a robust system in place to monitor the training of the GPs and staff within the practice. For example, not all clinical staff had received appropriate training in safeguarding, basic life support, fire safety, infection control and information governance to ensure they were up to date with current procedures.
• Comments cards we reviewed told us that patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients. In particular, fire safety, monitoring of the cold chain and high risk medicines.

• Ensure patients are protected from abuse and improper treatment.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular,significant events, infection control, legionella, recruitment, training and appraisal of staff, NICE guidance, quality improvement, complaints, shared learning from significant events and complaints, policies and procedures.

• Make reasonable adjustments for disabled people as per national guidance.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.

The areas where the provider should make improvement are:

• Improve the current processes in place for the monitoring of repeat prescriptions, referrals to secondary care and the scanning of incoming post.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice